Active NPI
Charlton Alan Wilson, MD
- Internal Medicine Physician
- Phoenix, AZ
National Provider Identifier
1467542720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 93-428
- Practice address
- 4212 N 16TH St
Phoenix, AZ 85016-5319 - Phone
- (602) 262-1511
- Fax
- (602) 263-1637
- NPI assigned
- Oct 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 93-428 | NM | Primary |
Addresses
Primary practice location
4212 N 16TH St
Phoenix, AZ 85016-5319
Mailing address
PO Box 31001-0698
Pasadena, CA 91110-0698
Phone (602) 263-1511
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 406787 | Medicaid | AZ | |
| AZ0713380 | Other | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 93-428 | NM | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1467542720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31001-0698",
"city": "PASADENA",
"state": "CA",
"postal_code": "911100698",
"telephone_number": "602-263-1511",
"fax_number": "602-263-1637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4212 N 16TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850165319",
"telephone_number": "602-262-1511",
"fax_number": "602-263-1637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CHARLTON",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-14",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NM",
"license": "93-428",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "406787",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "AZ0713380",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.